ENT Flashcards
What is otitis externa and sx
Acute inflammation of meatal skin
Minimal discharge, pain, itchy
Tragal tenderness
Organisms in otitis externa
Pseudomonas
S aureus
RF otitis externa
Swimming
Eczema, psoriasis
Trauma
Persistent infection of otitis externa
Malignant otitis externa
Temporal bone destruction
CN palsy
Base of skull osteomyelitis
Manage otitis externa
Swabs
Aural toilet
Sofradex
Acute otitis media sx
Fever, vomiting, ear pain and discharge
Viral UTI
RED bulging tympanic membrane with exudate
3 causes of otitis media
Pneumococcus
Haemophilus
Moraxella
Manage otitis media
PO CO AMOX
Mastoiditis - IV abx, myringotomy +- definitive mastoidectomy
Complications of otitis media - 5
Mastoiditis- middle ear inflammation leads to destruction of air cells in mastoid abscess and abscess formation - fever, tenderness, swelling, ear forward Labyrinthitis Facial n palsy Meningitis Intracranial abscess
What is choleastoma
Keratinising squamous epithelium in Middle Ear
Sx of choleastoma
Recurrent inf
Foul discharge
Hearing loss
Headache
Manage choleastoma
Mastoid surfeyr
Complciatoins choleastoma
Mastoiditis
Cerebral abscess
Facial n palsy
Otitis media with effusion ? Finding on otoscope
Glue ear
Dull, grey, yello
Bulging, retracting ear drum
Fluid level
Glue ear sx 4
Hearing
Language delay
Inattention
Recurrent inf
Glue ear tests 2
audiogram - shows conductive defect Impedance audiometry (blow air in and monitor what comes back) - flat tympanogram
Manage glue ear
Watch and wait - 3m reviews
Surgery with myringotomy and grommet
Hearing aids if bilateral and persistent
Cause of unilateral glue ear in adult
Malignancy - nasopharyngeal blocking eustachian tube entrance
4 causes of conductive hearing loss
External canal obstruction
Drum perforation
Infection
Problem with ossicular chain
7 causes of sensorineural hearing loss
Genetic Congenital infection Presbyacusis Ototoxic - gentamicin, furosemide, vancomycin Post infective Acoustic neuroma Ménière disease
Tinnitus what is it
Sensation of non verbal sound outside without stimuli in body
Causes of tinnitus
Local - presbyacusis, noise injury, head injury, menieres
General - CVS
Drugs - loop
Psychological
Menieres 4 sx
Vertigo
Aural fullness
Tinnitus
Sensory neural hearing loss
2 inv Ménière
Electrocochleogroahy
MRI
2 manage Ménière
Prochlorperazine
Beta histine
Acoustic neuroma sx 3
Ipsilateral tinnitus
Sensorineural hearing loss
Cerebellar signs if larg e
Diagnose acoustic neuroma
MRI head
Manage acoustic neuroma
Gamma knife radiotherapy surgery
Monitor
Causes of vertigo
Peripheral - menieres, labyrinthitis (long hx), choleastoma
Central - acoustic neuroma, head injury
Drugs - gentamycin, diuretics
What is BPPV
SuDden rotational vertigo for over 30s provoked by head turning
Caused by displacement of otoliths in semicircular canals
Causes of BPPV
Head injury
Middle ear disease
Post viral
Diagnosis of BPPV
Establish negatives eg hearing loss tinnitus
Hallpike test - test normal side first
Treat BPPV 4
Self limiting
Epley manoeuvre
Vestibular rehab exercise
Betahistine, prochlorperazine
Where does inferior meatus drain
Nasolacrimal duct
Where does middle meatus drain
Maxillary
Frontal
Anterior ethmoid cells
Rhinosinusitis and 2 types
Inflammation of nose and paranasal sinuses with 2 or more of
- nasal congestion or discharge
- facial pain or pressure
- reduced smell
- post nasal drip
Acute under 12h or chronic 5or more episodes
Diagnosis rhinosidinusis
CT sinus
Manage rhinusinusitis
Acute - bloods Topical corticosteroids PO antibiotics Nasal douches Chronic - FESS
Where are nose bleeds more common
Kisselbach’s area
4 vessels in nose
LEGS Superior labialise artery Anterior and posterior Ethmoidal Greater palatine Sphenopalatine
Manage epistaxis
Stop anticoagulation, FBC, cross match
Pinch lower of nose while mouth breathing
Cautery if small
Ongoing - anterior nasal pack or posterior nasal pack (foley catheter)
Examine throat
May need EUA or ligation
Consider causes - trauma, haem
Organisms in tonsillitis
Group a strep
Moraxella caterhalis
3 differentials tonsillitis
EBV
Agranulocytosis
Scarlet fever
Manage tonsillitis
Paracetamol and difflam
Pen v for 10d
Recurrent attacks - tonsillectomy
Complications tonsillitis (2) and manage
Retropharyngeal abscess - extended neck - torticolis - lateral neck X-RAY, CT neck, I&D in theatre Peritonsilar abscess - quinsy - uvula deviation - trismus - muffles coice - antibiotics and aspiration
Tonsillitis 4 sx
Sore throat
Difficulty swallowing
Fever
Lymphadenopathy
Acute epitltotiits sx 4
Sepsis
Stridor
Dyspnoea
Drooling
Manage epiglottis 3
Nebulised adrenaline
IV dexamethasone
IV penicillin and ceftriaxone
Midline neck lumps 4
Dermoid cyst (<20yo)
Thryoglossal cyst - fluctuant, moves in tongue protrusion, from thyroid migration
Thyroid mass - systemic thyroid features, features of mass
Chondroma
4 lumps in submandibular triangle
Lymphadenopathy
Submandibular stone
Submandibular tumour
Sialadenitis
Mass in posterior triangle
Malignancy (parotid) or infectoin - nodes
Anterior triangle mass 3
Branchial cyst - on ant border of SCM, from cervical sinus persistence. Squamous epithelium, cholesterol crystals in fluid
Cystic hygroma
Carotid body tumour - moves side to side, firm, pulsatile, diagnosis on mri
Neck lumps inv
USS
CT
FNA
Bloods
RF for otitis media
URTI Adenoids Malformations eg cleft palate Asthma Bottle feeding, dummy Smoking GORD
Causes of laryngeal nerve palsy - 4
Cancers - larynx, thyroid, bronchus, oesophagus
Iatrogenic - parathyroidectomy, oesophageal or pharyngeal pouch surgery
CNS disease
Aortic aneurysm
Sx of laryngeal nerve palsy - 3
Vocal cord paralysis - innervates adduction and abduction
Weak breathy voice, weak cough
Exertional dyspnoea - narrow airflow
Cough/aspiration
Inv recurrent layngeal n palsy
If no hx of surgery: CXR CT if clear US thyroid OGD
Causes of dysphagia
Malignant - oesophageal, pharyngeal, gastric, lung
Neuro - bulbar palsy, myasthenia gravis
Benign stricture, pharyngeal pouch, systemic sclerosis
Complicatiotns of tonsillitis - 4
Otitis media
Sinusitis
Peritonsillar abscess - quinsy
Pharyngeal abscess
What is peritonsillar abscess sx
Quinsy - sore throat, dysphagia
Peritonsilar bulge, uvular deviation
Trismus, muffled voice
Abx and aspiration
complications of tonsillectomy
Primary haemorrhage - surgery
Secondary haemorrhage - infection of tonsillary fossa - support, surgery, IV abx
